Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- disturbed cognition during event (confusional arousals, sleep terrors, sleepwalking)
- vigorous activity or violent behaviour (confusional arousals, sleepwalking, sleep terrors, and rapid eye movement sleep behaviour disorder [RBD])
- episodes of inability to move (isolated recurrent sleep paralysis)
- autonomic hyperactivity during event (sleep terrors)
- amnesia
- normal physical examination between episodes
Other diagnostic factors
- abnormal demeanour and facial expression (confusional arousals, sleepwalking, sleep terrors)
- evidence of injuries
Risk factors
- FHx of NREM parasomnias (confusional arousals, sleepwalking, sleep terrors)
- presence of HLA gene DQB1*05 and *04 alleles (sleepwalking)
- psychiatric medications or alcohol
- hx of psychiatric disorder
- fever
- acute sleep deprivation or irregular sleep-wake schedule disorder
- emotional stress and traumatic life events
- forced awakenings
- untreated comorbid sleep disorders
- premenstrual state (in adolescent girls)
Diagnostic investigations
1st investigations to order
- clinical examination
- polysomnography (rapid eye movement sleep behaviour disorder)
Investigations to consider
- polysomnography (confusional arousals)
- polysomnography (sleepwalking)
- polysomnography (sleep terrors)
- polysomnography (nightmare disorder)
- polysomnography (all other parasomnias)
- polysomnography with expanded EEG video recording
- urine drug screen
Treatment algorithm
Contributors
Authors
Co-Director, Pediatric Sleep and Research Center
Cardinal Glennon Childrens Hospital
Associate Professor of Neurology
Saint Louis University School of Medicine
St Louis
MO
Disclosures
RM declares that he has no competing interests.
Co-Medical Director, Sleep Medicine and Research Center
St. Luke's Hospital
Adjunct Associate Professor
Department of Pediatrics
Saint Louis University School of Medicine
St Louis
MO
Disclosures
SP receives royalties from UpToDate for writing two topics: diagnosis and management of pediatric obstructive sleep apnea.
Dr Raman Malhotra and Dr Shalini Paruthi would like to gratefully acknowledge Dr Alon Y. Avidan, the previous contributor to this monograph. AYA has been paid honorarium speaking fees by the American Academy of Sleep Medicine, the American Academy of Neurology, the American College of Chest Physicians, Sepracor Inc, Cephalon Inc, and Pfizer Pharmaceuticals.
Peer reviewers
Consultant in Paediatric Neurodisability
Evelina Children's Hospital
St Thomas' Hospital
London
UK
Disclosures
PG is lead applicant on the ongoing MENDS trial, which is concerned with the use of melatonin in children with neurodevelopmental disorders and impaired sleep.
Reader in Psycho-Social Intervention
Centre for Evidence Based Intervention
Barnett House
University of Oxford
Oxford
UK
Disclosures
PM has received funding greater than 6 figures USD from the Swedish Board of Health and Welfare, Martek Biosciences, Danish Social Research Institute, UK Department of Health, UK Health Technology Assessment Programme. PM declares that he has no competing interests.
Associate Professor of Pediatrics
Chief
Division of Pulmonary and Sleep Medicine
Department of Pediatrics
Medical College of Wisconsin
Medical Director
Pulmonary Clinic
Children's Hospital of Wisconsin
Milwaukee
WI
Disclosures
LAD declares that she has no competing interests.
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